13 Contents Signs and symptoms edit ra primarily affects joints, but it also affects other organs in more than 1525 of individuals. 14 joints edit a diagram showing how rheumatoid arthritis affects a joint Arthritis of joints involves inflammation of the synovial membrane. Joints become swollen, tender and warm, and stiffness limits their movement. With time, multiple joints are affected ( polyarthritis ). Most commonly involved are the small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. 15 :1098 Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.people as of 2015. 10 This is between.5 and 1 of adults in the developed world with 5 and 50 per 100,000 people newly developing the condition each year. 3 Onset is most frequent during middle age and women are affected.5 times as frequently as men. 1 In 2013, it resulted in 38,000 deaths up from 28,000 deaths in 1990. 11 The first recognized description of ra was made in 1800. Augustin Jacob Landré-beauvais (17721840) of Paris. 12 The term rheumatoid arthritis is based on the Greek for watery and inflamed joints.
1, the underlying mechanism involves the body's immune system attacking the joints. 1, this results in inflammation and thickening of the joint capsule. 1, it also affects the underlying bone and cartilage. 1 The diagnosis is made mostly on gescheurde the basis of a person's signs and symptoms. 2 X-rays and laboratory testing may support a diagnosis or exclude other bacterie diseases with similar symptoms. 1 Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others. 2 The goals of treatment are to reduce pain, decrease inflammation, and improve a person's overall functioning. 5 This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. 1 pain medications, steroids, and nsaids are frequently used to help with symptoms. 1 Disease-modifying antirheumatic drugs (dmards such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease. 1 biological dmards may be used when disease does not respond to other treatments.
Rheumatoid arthritis - wikipedia
For juvenile rheumatoid arthritis, see juvenile idiopathic arthritis, rheumatoid arthritis rA ) is a long-term autoimmune disorder that primarily affects joints. 1, it typically results in warm, swollen, and painful joints. 1, pain and stiffness often worsen following rest. Most commonly, the wrist hengstig and hands are involved, with the same joints typically involved on both sides of the body. 1, the disease may also affect other parts of the body. 1, this may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. 1, fever and low energy may also be present. 1, often, symptoms come on gradually over weeks to months. 2, while the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors.
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Collaborate with physical therapy in developing and executing an exercise programe to maintain and improve joint function Explain to patient/ family the purpose and plan for joint exercises to provide information and support for the patient. Initiate pain control measures before beginning joint exercises (hot packs, warm shower) to relieve stiffness and increase mobility. Assist patient to optimal body position for passive/active joint movements (with correct application of resting splints, selection of properly fitting footwear and selection and use of assistive devices) to prevent or limit joint deformity. Nursing diagnosis: Disturbed body image related to chronic disease activity, long term treatment, stiffness, and inability to perform usual activities goal: Improved self image. Interventions Identify effects of patients culture, religion, race, sex and age in terms of body image to determine extent of problems Assist patient to discuss changes caused by illness or surgery to identify problems and plan treatment. Facilitate contact with individual with similar changes in body image to promote sharing and socialization. Nursing diagnosis: Fatigue related to increased disease activity, pain, inadequate sleep/rest. Goal: Relief from fatigue.
Surgical procedures include synovectomy (excision of the synovial membrane) tenorrhaphy (suturing tendon) and arthroplasty (surgical repair and replacement of the joint) Nutrition Therapy patients with ra frequently experience anorexia, weight loss, and anemia. A dietary history identifies usual eating habits and food preferences. Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair. For the extremely anorexic patient, small, frequent feedings with increased protein supplements may be prescribed. Some medications (ie, oral corticosteroids) used gezicht in ra treatment stimulate the appetite and, when combined with decreased activity, may lead to weight gain. Therefore, patients may need to be counselled about pain eating a healthy, calorie-restricted diet.
Difference between Osteo and Rheumatoid arthritis Osteoarthritis Rheumatoid Arthritis Pathology Progressive process of central cartilage (spurs) destruction Peripheral bone growth in joint Progressive process marked by exacerbations and remissions Inflammation of synovial membrane with cartilage damage and bone destruction Ligament, tendon, and joint capsule damage. Intervention Perform a comprehensive assessment of pain to include location, characteristics, onset/duration, frequency, quality, intensity or severity of pain and precipitating factors to establish a pattern and baseline assessment evaluate with patient and health care team, effectiveness of past pain control measures that have been. Teach use of non pharmacologic techniques (relaxation, distraction, hot/cold application, massage) before pain occurs or increase and along with other pain relief measures, to promote muscle relaxation and decrease tension. Provide the person with optimal pain relief with prescribed analgesics to help to decrease pain and inflammation. Nursing diagnosis: Impaired physical mobility related to joint pain, stiffness and deformity goal: Improved physical mobility. Intervention Determine limitation of joint movement and effect on function to establish baseline for plan of care.
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Feet, stiff painful broadened forefoot, depressed metatarsal heads cockup toe deformity. Systemic effects fever, malaise, weakness, wt loss, numbness, enlarged lymph nodes, enlarged spleen, depression anorexia diagnosis of Rheumatoid Arthritis Patients subjective evaluation Degree of joint pain Duration of morning stiffness Presence/absence of fatigue Functional limitation(s) Physical examination Actively inflamed joints. Management goals Early and aggressive disease control Early/Undiagnosed: nsaids, short course corticosteroids Late/Uncontrolled: dmard (Disease modifying anti rheumatic drug) therapy. Non pharmacology Pharmacology referral to pt/ot evaluate adls Assistive devices/splints weight loss Smoking cessation Anti-inflammatory Analgesics nsaids Glucocorticoids dmard anticytokine therapy Analgesics Tylenol Opiods Diclofenac nsaids: Mechanism of Action Cyclo-oxygenase inhibition cox-1 cox-2 cox cyclo-oxygenase is an enzyme involved in inflammatory process. Cox 2 inhibitors blocks the enzyme involved in inflammation while leaving intact the enzyme involved in protecting the stomach lining. As a result cox 2 inhibitors are less likely to cause gastric irritation and ulcer than nsaid.
Nsaids: cox-2 Inhibitors Improved gi tolerability reduced effects on renal blood flow no effect on platelet function Pros and Cons of nsaid therapy Pros Cons Effective control of inflammation and pain Effective reduction in swelling Improves mobility, flexibility, range of motion Improve quality of life. If symptoms appear to be aggressive methotrexate may be considered. Methotrexate: considered as the drug of choice for. It produces a beneficial effect in 2-6 weeks and is given once weekly. The usual dose.5-15 mg once a week. The most common side effect is gastric irritation and stomatitis. Other side effects are hepatotoxicity, pancytopenia and interstitial pneumonitis. Advantages of dmards Slow disease progression Improve functional disability decrease pain Interfere with inflammatory processes Retard development of joint erosions Surgery for persistent erosive ra, reconstructive surgery used. Surgery is indicated when pain cannot be relieved by conservative measures.
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Rheumatoid nodules, radiographic changes, first four criteria must be present for 6 weeks or more. Pathophysiology of ra, presentation of antigen to t cells leading to t- and B-cell proliferation and Angiogenesis in synovial lining resulting in Swelling in small joints, associated with pain, stiffness, and fatigue. Neutrophil accumulation in synovial fluid causes Cell proliferation. Cartilage invasion may be there resulting in Warm, swollen, effusions, pain, and decreased motion with possible rheumatoid nodules. Sign and symptoms. Sign and symptoms, eyes, episcleritis, keratoconjuctivitis, synovial joints. Warm tender red painful guarded movements, limited rom, limited strength. Stiffness and pain worst in morning. Hands, red palms, testicular enlarged dorsal veins, pain and stiffness weak grip, inability to make tight fist.
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Disease severity, mild disease, arthralgias 3 inflamed joints. Mild functional limitation, minimally elevated esr crp, no erosions/cartilage loss. No extraarticular disease. Anemia, moderate disease 6-20 Inflamed joints, moderate functional limitatio. Elevated esr/crp, radiographic evidence of inflammation, no extraarticular disease. Severe disease 20 persistently inflamed joints, rapid decline in functional capacity, radiographic evidence of rapid progession of bony erosions loss of cartilage. Extra articular disease: hele Hypoalbuminemia, acr criteria for diagnosis, four or more of the following criteria must be present: Morning stiffness 1 hour. Arthritis of 3 joint areas. Arthritis of hand joints, symmetric swelling (arthritis serum rheumatoid factor.
An autoimmune etiology is currently the pijn most widely accepted. Autoimmunity the autoimmune theory suggests that changes associated with ra begins when a susceptible host experiences an initial immune response to an antigen. The antigen which is probably not the same in all patients triggers the formation of an abnormal immunoglobulin G (IgG). The autoantibodies are known as rheumatoid factor (RF) and they combine with IgG to form immune complexes that initially deposit on synovial membranes or superficial articular cartilage in the joints. Genetic factors genetic predisposition appears to be important in the development. G a higher occurrence of the disease has been noted in identical than in fraternal twins. The strongest evidence for a familial influences is the increased occurrence with hla( human leukocyte antigen).
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Ra is a chronic, systematic autoimmune disease characterized by inflammation of connective tissue in the synovial joints, typically with periods of remission and exacerbation. Ra is frequently accompanied by extra articular manifestation. Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can koorts also cause inflammation of the tissue around the joints, as well as in other organs in the body. Women are affecting 2-3 times more often than a men. Ra is most common in people between the ages of 20-30. The incidence of ra is about 1-3 per100. Etiology of ra, the cause of ra is unknown. Usually insidious associated with physical and or emotional stress.